Abstract

Introduction

Unsedated ultrathin endoscopy has been proposed as a cost-effective and accurate alternative to standard endoscopy (SE) in screening for oesophageal varices, Barrett’s oesophagus and upper GI neoplasia. However, reports on performance of this technique (both via the transnasal [TNE] and transoral [TOE] routes) are conflicting. We aimed to estimate the technical success rate, tolerability, acceptability and patients’ preference for TNE and TOE alone and in comparison to SE.

Methods

A systematic review and meta-analysis was performed of all primary studies reporting the outcomes of interest. Electronic databases (Cochrane library, MEDLINE, EMBASE) were searched from 1980 to September 1st 2013. Articles not published in English language were excluded.

Methods

Detailed data on study characteristics and endoscopic procedures was extracted. Study quality was assessed using the Cochrane Collaboration’s tool for assessing risk of bias. Sources of heterogeneity were investigated using meta-regression and subgroup analysis.

There is no difference between TOE and SE in terms of technical success rate and preference. Success rate of TNE <6 mm in diameter is equivalent to SE, but majority of patients prefer the former over the latter. Hence, TNE (<6 mm in diameter) should be the procedure of choice for screening. Modern disposable and portable TNE devices might be useful for screening in the community.